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�,rurc urriLe u5------------------ n,t=: . :.. . �j <br /> l <br /> ---...._-..--..-.- APPLICATION FOR SANITATION PERMIT Permit No. �__ _: <br /> -----------:------ ------ ----------------- --------- (Complete in Duplicate) <br /> Date Issued <br /> ..................................................... This Permit Expires 1 Year From Date Issued <br /> _k Application is hereby made to the San Joaquin Local Healfh District for a permit to construct and install the work herein described. <br /> This application is made in compliance with County Ordinance No. 549_ <br /> A JOB ADDRESS AND LOCATI N. ,___ (� v._-f�llzd<.-.!(4 _. _ ------------�^- a- - -:-------- - <br /> - ------------------------ <br /> Owner's Name_--Vr ----------- Phone----••-------------------------•---- <br /> 1� - ------------------------- <br /> Address------T=---7-----�-- � - -- --- 4 r <br /> { -------------- ----- -- ------ ------•--------------- <br /> Contractor's Name f --� .1-------------------------- Phone------ ----------------- <br /> r— Installation will serve: Residence [/Apartment House ❑ Commercial ❑ Trailer <br /> Court ❑ Motel ❑ Other ❑ <br /> N Number of living units:.__'�Number of bedrooms _-��_ Number of baths _y-- Lot size ___________________________________•_______--___--_-._____- <br /> Water Supply: Public system ❑ Community system ❑ Private Er-IDepth to Water Table -------- ft. <br /> Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe Hardpan ❑ <br /> Previous Application Made: (If yes,date---------...--------) No ❑ New Construction: Yes ❑ No ❑ PHA/VA: Yes ❑ No ❑ <br /> TYPE OF INSTALLATION AND SPECIFICATIONS: <br /> (No septic tank or cesspool permitted if public sewer is available within 200 feet.) <br /> Septic Tank: Distance from nearest well------ ---------_Distance from foundation--------------------Material-----------------------------__________________. <br /> ❑ No. of compartments----------- ............Size-------------------------------Liquid depth---- ----- -------------._Capacity----------------------- <br /> t~ <br /> Disposal Meld: Distance from nearest ---Distance from foundation..-.�Q____- -----Distance to nearest lot line__----------- <br /> Number of lines---------/------------------------Length of each line-------9---p-----------------Width of trench... -.___-_____.____________ <br /> I <br /> 1 Type of filter material_____S.tIZ_f_.__`___Depth of filter material-------13_"__...__Total length------41,0__-e_______________________ <br /> Seepa Pit: Distance to nearest well-----�gP.___�_Distance from foundation--------1_0 4'-__.Distance to nearest lot iine_.S__/__ <br /> -- <br /> iNumber of pits--------I------------Lining material------$-R-_t------size, Diameter--------- Depth--- --------------- <br /> F, Cesspool: Distance from nearest well-----------------Distance from foundation--------------------Lining material-------------------------------------- <br /> EJ Size: Diameter--------------------------------------De th------.---------.--------------_--.----------- -Liquid Capacity als. <br />} Privy: Distance from nearest well-__---------------------------------------------Distance from nearest building <br /> ❑ Distance to nearest lot {ine------ --------------------------- - -- ------- •-------;-------------------- ---� - � <br /> f ,. Remodeling and/or repairing (describe):--------------------- <br /> --------------•------------------------•-------------------•--•----------`` rr 7--- ------ ---------------••-•-•--•----------------- ------ <br /> F - -- ------------------------------••--------•----------------••--•••-----------•----- <br /> - ---------------------------•--------------- ------------------------------------------------------------------------------------•---------------------------------------------------------------------------------------- <br /> I herebXYSfates, <br /> I have prepared this application and that the work will be done in accordance with San Joaquin County <br /> ordinances, d rules and regulations of the San Joaquin Local Health District. <br /> (Signed)------- -- ------- ---- --- ---- - ------------ ----------------------------- ----------. end/or Contractor) <br /> By:--- -------- <br /> on o sysfem in relation fo wells, buildings, etc., can be placed on reverse side). <br /> FOR DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED BY - ------- - ----------------------------------------------- --- DATE---Z-��T----------------------------------- <br /> + 0. . REVIEWED BY--------------------------------- ----------- -------------------------------------------------------------- ----------------- DATE-----------------•----------- ------------------------------ <br /> iBUILDING PERMIT ISSUED------------------------------ -------------------------------—-------------•------------------------ DATE------------------------ <br /> Alterationsand/or recommendations-------------------------------------------------•------ -----------------------------------------------------...---------------•------------------------------ <br /> -------------------•--------------------------------------------------- ---- - -------------------------------------------------------------------------•------------------------------ ------------------------------.._.... <br /> = --- --------------• ---- ----------------------------------------------------------------------------------------------- ----------------------------------- ---------------------------- <br /> F- <br /> ------------------------- ------------ ---------------------•-------- <br /> FINAL INSPECTION BY:.... .. ......... _�' <br /> c '��------------- Date <br /> t SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> 1601 E.Hazelton Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street <br /> Stockton,California Lodi, California Manteca,California Tracy,California <br /> F.F.Co. <br /> { <br />